Healthcare Provider Details

I. General information

NPI: 1851101612
Provider Name (Legal Business Name): MISSISSIPPI INFUSION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N STATE ST STE 101
JACKSON MS
39202-2478
US

IV. Provider business mailing address

1190 N STATE ST STE 101
JACKSON MS
39202-2478
US

V. Phone/Fax

Practice location:
  • Phone: 601-345-4525
  • Fax: 601-345-4535
Mailing address:
  • Phone: 601-345-4525
  • Fax: 601-345-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WENDELL R HELVESTON
Title or Position: OWNER
Credential: MD
Phone: 601-345-4525